Physiatry DefinitionPHYSIATRYFrom Greek physikosphysical and iatreiaart of healingKnow as Physical and Rehabilitation MedicineHistorical PerspectivePhysical modalities date back to ancient timesModern ID: 892422
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1 WHAT IS A PHYSIATRIST?Tamar Kessel, MDMa
WHAT IS A PHYSIATRIST?Tamar Kessel, MDMay 10, 2017 Physiatry: DefinitionPHYSIATRY:From Greek physikos(physical) and iatreia(art of healingKnow as Physical and Rehabilitation Medicine Historical PerspectivePhysical modalities date back to ancient timesModern medical specialty began to develop d
2 uring Coalesced during and after WWII, a
uring Coalesced during and after WWII, and the polio epidemicAddressing need for rehabilitation of injured veterans and polio survivorsPhysiatryformally recognized as medical specialty in 1947Today, over 11,000 boardcertifies physiatrists nationwide Physiatry: Myths and TruthsPHYSIATRISTS ARE&
3 #133;MDs and DOsAble to diagnose and pre
#133;MDs and DOsAble to diagnose and prescribeLocated throughout the U.S.Available for inpatient and outpatient careIntegral members of the care teamPHYSIATRISTS ARE NOT…In competition with PCPsPhysical therapists (physiotherapists)ChiropractorsPsychiatristsPodiatrists Physiatry: Training
4 year medical schoolResidency programs78
year medical schoolResidency programs78 accredited programs listed in the US in 20151 year internal medicine prelim, surgical prelim, or transitional year3 years PM&R trainingFellowshipsFellowship programs allow for subspecializationE.g., spinal core injury, sports medicine, pain Subspecialty/
5 Fellowship TrainingSubspecialty fellowsh
Fellowship TrainingSubspecialty fellowships accredited by the ACGME for physical medicine and rehabilitation includeHospice and palliative medicineNeuromuscular medicinePain medicinePediatric rehabilitationSpinal cord injury medicineSports medicineTraumatic brain injury Subspecialty/Fellowship
6 TrainingNonACGME accredited fellowships
TrainingNonACGME accredited fellowships available for physical medicine and rehabilitation includeCancer rehabilitationMultiple sclerosisNeurorehabilitationResearchSpine rehabilitation/interventional spine PhysiatricApproachGuiding principles:Patient FUNCTIONand QUALITY OF LIFEIntegrated care
7 Combine pharmacological and nonpharmacol
Combine pharmacological and nonpharmacological modalitiesNonsurgicalapproach and treatment and rehabilitationCoordinate interdisciplinary treatment teamWork with PCP, specialists, physical and other therapists Multispecialty ApproachResidency training is unique in its multispecialty process, w
8 hich allows for a very unique patient ca
hich allows for a very unique patient care approachPhysiatrists receive formal orthopedic, rheumatologic, musculoskeletal and neurologic training to care for patients in both inpatient and outpatient settingsPhysiatrists perform electromyography, musculoskeletal ultrasound and advanced spinal/
9 joint injectionsPriority is to avoid sur
joint injectionsPriority is to avoid surgery while maintaining function Physiatry: Improving FunctionGoal is prevention, diagnosis, and treatment of disorders that may produce temporary or permanent impairmentRestoration of functionMaximize quality of life“Wholeistic” approach (the w
10 hole patient, not just a body part): pat
hole patient, not just a body part): patientcentered care Practice Settings: InpatientLeads an interdisciplinary team (physical, occupational and/or speech therapist, social worker, psychologist and chaplain)Oversees the medical component as well prescription of therapeutic modalitiesTypically
11 treats spinal cord injury, brain injury
treats spinal cord injury, brain injury (traumatic and nontraumatic), stroke, multiple sclerosis, polio, burn care, and musculoskeletal and pediatric rehabilitation Practice Settings: OutpatientExperts at nonsurgical management of conditions including orthopaedic injuries, spinerelated pain a
12 nd dysfunction, occupational injuries an
nd dysfunction, occupational injuries and overuse symptoms, neurogenic bowel/bladder, pressure sore management, spasticity management and chronic painTypically practice in multidisciplinary groups with other physiatrists, orthopaedic surgeons and/or neurosurgeons Physiatry: Conditions TreatedM
13 usculoskeletalTrauma and injuries:Sports
usculoskeletalTrauma and injuries:Sportsor workrelated injuries, repetitive use disorders (e.g., carpal tunnel syndrome)Acute and chronic pain syndromes:Back/neck painDiseasesOsteoporosis, arthritisOtherRehabilitation following joint reconstruction, amputation Physiatry: Conditions TreatedCard
14 iovascularCardiac rehabilitationVascular
iovascularCardiac rehabilitationVascular diseasesPulmonaryCOPDOther respiratory dysfunctionOthers include:Rehabilitation for cancer, HIV, pediatrics, geriatrics Physiatry: Conditions TreatedNeurologicSpinal cord injury, traumatic brain injuryStrokeMultiple sclerosisPeripheral neuropathyMovem
15 ent disorders: Parkinson’s disease,
ent disorders: Parkinson’s disease, cervical dystonia, and other focal dystoniasMotor neuron disease The Physiatric Approach to CareExamples:Traumatic brain injury: improve cognitive and social functioning and returnwork issuesAcute disc herniation: maximize function and decrease pain wit
16 h various injection techniques (includin
h various injection techniques (including epidurals) and physical therapy, while avoiding surgical interventionPosthip replacement: decrease pain and improve functional gait/activitiesSprained ankle: strengthen and improve proprioception The Physiatric Approach to CareExamples:Post MI: optimi
17 ze cardiopulmonary functionSpinal cord i
ze cardiopulmonary functionSpinal cord injury: manage spasticity and assess need for appropriate adaptive equipmentPoststroke: increase mobility and range of motion in patients with spasticity, use focal treatment with botulinum toxin or phenol injection in conjunction with physical/occupation